1 / 20

Aarogya Samrakshana Ayalkoottam Neighborhood Health Protection Groups

Aarogya Samrakshana Ayalkoottam Neighborhood Health Protection Groups. Making Difference Together. National Health and Allied Services Cooperative (Proposed) Toms K Thomas Founder CEO, MARG Mutual Assistance Resource Group Lala Appartments, Flat No-3

andres
Download Presentation

Aarogya Samrakshana Ayalkoottam Neighborhood Health Protection Groups

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Aarogya Samrakshana AyalkoottamNeighborhood Health Protection Groups Making Difference Together National Health and Allied Services Cooperative (Proposed) Toms K Thomas Founder CEO, MARG Mutual Assistance Resource Group Lala Appartments, Flat No-3 P.O Ayyanthole-Thrissur- Kerala – India www.margindia.org / www.margasia.org

  2. Vision MARG Community Transformation, through Mutual Assistance, CommunityNeighborhood Investment, Cooperation & Partnership.

  3. Mission -MARG Provision of Appropriate Human Development Services inclusive of Public Health for all segments particularly the most Vulnerable and Marginalized irrespective of caste, creed, religion or gender, thus Enabling the Communities to Identify and Pool Local Resources to develop Community Owned Health and Development Financing institutions.

  4. Major Entities • National Health and Allied Services Cooperative (NHASCO) – In the Process of Initiating a Multi State Cooperative which work exclusively on Health Care Financing. Registered under the Central Cooperative Societies Act. • Coverage – Kerala, Tamil Nadu, Chhattisgarh • Health Save International – In the process of initiating a Community Based Organized Savings for Health Care. This would facilitate Mobilizing of Health Investments at the local level through organized savings. Would be Registered as Company. • IMPORTANCE OF A REGULAR SAVING FOR HEALTH INSTEAD OF A ONE TIME PREMIUM

  5. FACTS • 60-80% of illness do not require any hospitalization – OUT PATIENT CARE + HOME BASED CARE – APPROPRIATE CARE • Some 40% of ILLNESS do not require any treatment at all – BUT PREVENTION + PRECAUTION – HEALTH EDUCATION • Over 70% of the HEALTH CARE in Rural areas are Provided by QUACKS -JHOLA CHAAP / SELF TREATED – HEALTH SEEKING PRACTICE • OVER 50% REACH A FACILITY ON AN IN APPROPRIATE TIME – DIFFERENT LEVELS IN SOUTH AND NORTH. - HEALTH CARE HEIRARCIES

  6. Health Protection • Not equal to MERE Health Insurance! • A Basket with Diverse Products which address various associated issues • Beyond Finance - About Appropriate Services - Quality Perceptions – Costly Services!! - Right Understanding of Prevention - Awareness about Appropriate Time to Access A Care Hierarchy- - FANCY MEDICARE / APROPRIATE CARE - NOT A ONE TIME EVENT – BUT A LIFE TIME PROCESS

  7. AAROGYA SAMRAKSHANA AYALKOOTTAMBELIEF • Insurance and Financial Protection is JUST ONE COMPONANT of Health Protection • Neighborhood Investment (MUTUAL HELP) is the best solution INCLUSIVE FINANCING • Institutionalizing Community based HEALTH Financing - COOPERATIVE • COMMUNITY CAPACITY and HEALTH AWARENESS • Insurance Literacy – BRIGDING RISK

  8. AAROGYA SAMRAKSHANA AYALKOOTTAMCONTENT • A group of 10 to 50 families living in a Neighborhood. • Who are concerned of the Health of One Another. • Willing to Mutually Invest in Health Protection (Not Taking Policy / Paying Premium). • Ready to Learn and Practice – Insurance Literacy & Health Awareness. • Network of Care Provides & Insurance Providers • WILL BE BROUGHT UNDER NHASCO BRANCH STRUCTURE

  9. The Enrolment Process • Open Ended • Develop Connections with existing community based groups and associations. • Make Presentations before the local leaders and institutions like churches, Local Governments / Panchayat , SHGs etc.. • 3 visits minimum before a group is prepared for enrolment

  10. How Does It Work • As a membership (Family) 4 – 2 below 60 Yrs and 2 Below 21 Yrs. WORKING ON LARGER INCLUSION. • Tamil Nadu – Annual Membership Fee INR.280 (INR 160 Insurance INR 100 Group Medical Fund, INR 20 Promotional Fee) – Processing Fee is raised Through Social Investment • Cost in Kerala – INR 500 (160 INS, 100 Processing Fee (INR 20 per Person), 100 Group Medical Fund, 120 OPD Fund) and INR 20 Promotional Fee. • Cost in Chhattisgarh – In the Process of working out

  11. How It Is Collected • Collected in Three Installments • Waiting Period of Three Months • First Installment is Rs.100 per family • Through the Branch Offices and Field Staff

  12. Entitlements • Family Floater Insurance = Rs.10000 through National Insurance Company • Insurance of assets and life Equivalent to Rs.10000 • Access to a group owned medical fund (Loan / Grant) – Which would be put under NHASCO • Education and Awareness Sessions HEALTH • Medical Counseling Centers (Including Life Style Illness Monitoring) – Under Process • In Kerala – Free OPD Consultation for a year for a family of 4 in a preferred hospital in the panel hospitals (This is in the process)

  13. How The Settlements Done • IP Admissions are Informed over phone • Staff verify the admission and the procedures. • Will have a practitioner who would follow up the treatment proceduers (PROCESS) • Upon Discharge all the documents are submitted to the HBMC • Health Benefit Management Committee (HBMC) forwards the settlements to MARG – NIC • INR 100 is charged by the HBMC as Claim Processing per Claim. • HBMC meet once in two weeks. • Claims for less than 1000 is reimbursed immediately.

  14. How Is It Financed • Cross Subsidizing of Premium • Mobilizing of Local Social Investment – In the process of developing an ECS Facility with HDFC Bank. • Local Donations

  15. An Ideal Branch Office • Unit Coordinator – Branch Manger - 1 • Community Organizers – 6 • Accountant – 1 • Insurance Officer – 1 • HO Cost Apportion – 8000 • District Office Cost Apportion – 5000 • State Office Cost Apportion - 5000 • Approximate cost would come to – 45000 • Enrolment / Branch for Break Even = 450/ Month

  16. Current area • Kerala • Tamil Nadu • Enrolments = 1000 families as on 30th November 2009. • Branches including HO = 4 • Proposed Branched by 31st March 2010 =10 • 3 Tamil Nadu • 4 Kerala • 3 Chhattisgarh • Catering to 54000 families (216000 members)

  17. Other Targets By March 2010 • Transformation in to a National Multi State Cooperative – NHASCO. • Registration of Health Save International in to a company. • Mobilizing of 3000 social investors who pay INR 100 a month for a year.

  18. AAROGYA SAMRAKSHANA AYALKOOTTAMOTHER TARGETS • Developing Alternative Care Tiers (In the Process) • Community Based LIFE STYLE ILLNESS COUNSELING CENTERS (In The Process)

  19. AAROGYA SAMRAKSHANA AYALKOOTTAMPARTNERSHIPS • Insurance Providers -National Insurance Company • Health care Providers - Ashtamudi Hospital and Trauma Care Centre, Kollam • Health Practitioners (In the Process)

  20. THA NK YOU.

More Related